Deconstructing Indian Maternal Health from Afar

In the past few weeks, much of my time for this research has been devoted to learning about maternal health care systems in India. For starters, how do new mothers choose a hospital for their care? What are the differences between private and public hospitals that motivate these choices? How do mothers choose an OB/GYN? How do they pay for these appointments? How are decisions made with the whole family? More importantly, how do doctors guide their patients through these decisions?

As I’ve read through more literature this summer, one of the biggest gaps I have seen is the lack of geographically-centered research on this issue in Telangana and Andhra Pradesh, as well as a dearth of extensive qualitative research methods used. Rising rates of C-sections is, by nature, a problem that is seen across all developing countries, as they reform their medical systems to reduce maternal mortality. Greater technological dependency in medicine has unknowingly placed surgery and other medical interventions on a pedestal over preventative care and noninvasive methods. As patient awareness grows over time, the role of the patient and family in medical decision-making increases, as well. Before the doctor can make a decision on patient safety and method of delivery during labor, many patients consult their own peers and research to present their own decision. Such decisions are influenced by many factors, such as their understanding of the pros and cons of each delivery method, pain tolerance, financial background, and more. Such factors seem to be playing a greater role more recently, as seen by these rising rates.

Over the last few weeks, as I began talking to more medical professionals who see and assist new mothers during childbirth, one of the most prevalent topics has been the patient side of decision-making. It has been interesting to hear providers speak about how violence against doctors and income status can sway decisions made by patients and providers. For example, a patient’s social status and financial capability can go so far as to motivate their decision to get a C-section. In such cases, patients’ families may be equating higher class to “better” care in the form of a C-section. From the providers’ end, an influencing factor can be the social pressure that comes in the form of violence against medical professionals. Many doctors cite fear of violence to be a factor in choosing the more predictable route of a caesarean delivery, even when this surgical procedure may be unnecessary.

Under such circumstances, it has been informative to learn of the various social factors that can impact medical decisions beyond the science itself. This also reveals the need for research to fill these gaps and ultimately explore the issues in an open-ended, qualitative manner that can then inform policy and health initiatives more precisely.

The experience of interviewing Indian medical professionals right from my bedroom has been challenging yet memorable for all these reasons. While phone interviews may not capture the full qualitative research experience that I had hoped for, it has given me a look into what a day in the hospital could look like and how a visit to the doctor entails so much more beyond sheer medicine itself. Interviews like these have motivated me to explore the political, social, and economic histories of these medical institutions that influence these trends in maternal health from the origin.

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About Neelu Paleti

Neelu is a rising senior from Dublin, Ohio, studying Health and Societies at Penn. Her research interests lie in maternal and child health policies, as well as the institutionalization of medicine in India. Her senior thesis research revolves around the construction of power, choice, and safety in caesarean deliveries in South India. This research will explore how broader themes of decision-making and patient-provider dynamics affect the rising rates of C-sections in regions of India.